title: Integration of family planning into HIV services: a synthesis of recent evidence.
abstract: BACKGROUND
  Increasing access to contraception among women who enter the health system for HIV care is crucial to help them achieve their fertility intentions and reduce vertical transmission of HIV. Identifying intervention strategies that contribute to effective family planning/HIV service integration and synthesizing lessons for future integration programming and research is important to move the field forward.
  
  
  METHODS
  Using a standard review methodology, we searched for articles in the peer-reviewed literature published between January 2008 and August 2013 that addressed the integration of family planning interventions into HIV service settings. Eligible studies were assessed in terms of methodological rigor; documented outcomes; and reported process and cost data.
  
  
  RESULTS
  Twelve studies met our inclusion criteria. Eight studies documented significant increases in contraceptive use by HIV service clients, and three reported significant increases in completed referrals from HIV services to family planning clinics. The outcomes of the seven studies implemented in public sector facilities were more modest than the five studies embedded in clinical trials. Process evaluation measures for some of the studies indicated weak implementation of the intervention as intended. The average rigor score was low, 3.4 out of 9.
  
  
  CONCLUSIONS
  Our review reveals an expanding evidence base for integrated family planning/HIV service delivery innovations. However, the modest observed effect under typical settings and the evidence of weak intervention implementation emphasize the need for stronger programmatic efforts and implementation research to address the health system obstacles to integrating these two essential services.
authors.affiliation: FHI 360, Research Triangle Park, North Carolina, USA.
authors.forename: Rose
authors.initials: R
authors.lastname: Wilcher
authors.forename: Theresa
authors.initials: T
authors.lastname: Hoke
authors.forename: Susan E
authors.initials: SE
authors.lastname: Adamchak
authors.forename: Willard
authors.initials: W
authors.lastname: Cates
mesh_terms: D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005193:Family Planning Services / Q000379:methods* / Q000458:organization & administration*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000517:prevention & control; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008297:Male